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... I ... I ... the ... the the ... I ... I ... welcome back to Opinion Journal why Mary Kissel ... the forty eight Texas now where in the active duty soldier is accused ... of killing three people ... and injuring sixteen others before turning the gun ... on himself ... Porsche and very very pleased to welcome American Enterprise Institute in Yale psychiatry stockists Alisa tell ... she's the author of brainwashed ... the seductive appeal of mindless neuroscience ... to talk a little bit about mental illness in the military ... selling we we don't know alot about this case yet in this particular soldier ... they generally speaking how easy or difficult is it in now ... when someone is about to go on a rampage like that's ... well we do know ... in this case Mary is ... that we know of ... some diagnoses we know that to ... Mr. Lopez was being treated for depression and anxiety ... and there was a question about poster Matic stress disorder ... although remember his deployments were into thousandeight in ... two thousand eleven so it's a little unusual that would come up at this late date ... but ... those are the diagnosis we heard about also sleeplessness ... the cause of these problems ... I we can tell anything about whether or not someone would ... would have a kind of outburst ... I he was taking a medication I called him the and ... and in very rare cases that's been associated with ... psychosis ... if it turns out that this gentleman was suffering psychosis ... is possible that there might be a link ... but basically what we are and what we're in need of ... is much more information on context ... what happened on before ... the rampage what he'd been talking about is why ... I he cites a kind just a month ago ... and the clinical notes indicated there was nothing exceptional so clearly something happened within that month but we don't know what it is we don't know if he was using an ... alcohol or drugs ... they're a lot of things to be filled in but simply based on the diagnoses we've heard ... there's ... really no reason to ... I expect ... that a person is at higher risk for this kind of extreme behemoth ... thing you mention PTSD and that's been a big issue since we've had so many soldiers ... returning from various wars over the past decade ... have we gotten better at understanding what exactly PTSD is and whether or not ... it can induce violent behavior ... it went pretty good at making a diagnosis ... of ... poster Matic stress disorder ... there are three basic constellation of symptoms ... and they include hyper vigilance that kind of fun standing on the environment but you can imagine very adaptive in a wartime situation when one is under stress ... I it's also marked by a weak on what we call re experiencing symptoms like intrusive ... memories or nightmares and also by not what we call a boy and so in other words ... a classic example is the isthe ... often a fear of lights a riding on a high a way ... because in Iraq or Afghanistan that's where one can encounter ITT so you you're very ... leery of situations that are reminiscent of situations in wartime and post a great friend those are the basic constellation of symptoms ... they have to interfere with your ... a functioning everyday ... and we can make that diagnosis of what we can't tell is whether or not that person will overcome it nationally ... on his own ... of whether he or she requires treatment ... or whether it be that person is going to even be so ... debilitating that he might even need disability payments from the VA we cannot tell that kind of ... I'll come in cross section ... the good news is that we develop some I effective ... therapies for PTSD ... of oneness and one is called um ... kind of exposure therapy where the veteran is gradually re exposed to the conditions that ... have caused so much anxiety ... I and down kind of cognitive behavioral therapy as well ... but marry that's not ... a alone that's that's often not enough there's Battle therapy that's very important ... employment is is he ... the cause a lot of veterans have problems with sleep ... and anxiety in some depression ... but it's it's ... they can be worsened or improve tremendously if they see a future for themselves if there is employment if there is support from their family and their community if there been told if they've been told by their doctors that look this is temporary ... and it will get better and you will live a productive life the systems are ... in some ways also quite dependent on how a person sees their situation and expectations okay well ... there's an awful lot debt to think about were going to learn more about this case ... in the coming hours and days but for now ... we appreciate the commentary American